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Following the success of a controlled trial of insecticide-impregnated bednets in reducing mortality in children, The Gambia started a National Impregnated Bednet Programme (NIBP) in 1992. The objectives of this programme were to introduce impregnated bednets into all primary health care (PHC) villages and to establish a system of cost recovery over a three-year period. During the initial phase of the programme, when insecticide was given out free, a high uptake was achieved. However, after small user charges were introduced in 1993, coverage dropped to a low level. In 1994, different systems of insecticide distribution and permethrin formulations were tried in an attempt to improve coverage. A nationwide cross-sectional survey carried out during the 1994 rainy season measured coverage by distribution channel, as well as the knowledge, attitudes and practices of health workers and villagers during the intervention Overall, only 16% of bednets were impregnated in 1994, compared to 80% when the insecticide was offered free of charge in previous years. Lack of money was the major reason given by villagers for not impregnating their bednets in 1994. Use of impregnated \ was higher in areas where the sale of permethrin emulsion by village health workers was supplemented by the sale of insecticide in individual packages through shops. In villages where insecticide was distributed free to women with small children through governmental mother and child health (MCH) services, higher levels of coverage were achieved among women and young children than in villages where other distribution systems were used. We conclude that the sale of insecticide through the private sector may increase bednet impregnation rates in African communities, and that the free distribution of insecticide through MCH services may be an effective way of targeting young children, the group most at risk of malaria. Key words - malaria, bednets, permethrin, PHC, Gambia

The paper deals with a number of issues arising from the design and implementation of tourism policies and programs in The Gambia. It gives a description of tourism in the Gambian economy and discusses the reasons for success in this sector. A number of recommendations are put forward related to the need to increase earnings from tourism and to reduce the incidence of black markets. The overall conclusion of the paper is that a shift toward more cautious and flexible policies would benefit the tourism sector in The Gambia and thus make the programs intended to assist this sector more effective. It is on that basis that the country will attract more foreign tourists, and improve the standards and quality of products. The programs must also be executed in a careful, sensitive and planned manner that ensures the cooperation of the local communities.

A community trial was conducted in rural Gambia in order to determine whether a community-based intervention designed to mobilize latent demand for contraception would increase use of modern contraceptives, even [...]